title: Screening for latent tuberculosis infection in patients with chronic inflammatory arthritis: discrepancies between tuberculin skin test and interferon-γ release assay results.
abstract: OBJECTIVE
  Screening for latent tuberculosis infection (LTBI) is mandatory before initiating biologics in patients with chronic inflammatory arthritis (CIA). However, few studies have evaluated the discrepancies between the results of tuberculin skin test (TST) and interferon-γ release assays (IGRA) in these patients. The purpose of our study was to investigate factors associated with TST and IGRA results in a large cohort of patients with CIA before the introduction of biologics.
  
  
  METHODS
  A total of 563 consecutive patients with CIA (293 rheumatoid arthritis, 270 spondyloarthritis) and eligible for biologics were prospectively enrolled. Demographic, clinical, and biological data were recorded. Risk factors for LTBI were assessed. All patients underwent a TST, a chest radiograph, and an IGRA test (T-SPOT.TB).
  
  
  RESULTS
  Agreement between the 2 tests was low (κ = 0.16). The bacillus Calmette-Guerin (BCG) status was significantly associated with discordance between the 2 tests (p = 0.004). The TST positivity rate was 34.8%. Factors associated with a negative TST were female sex (p = 0.02) and immunosuppressive treatment (p = 0.003). The only LTBI risk factor associated with TST positivity was an abnormal chest radiograph (p = 0.02). T-SPOT.TB was positive in 21.7% of patients and indeterminate in 15.6%. Previous active TB and chest radiograph abnormalities were associated with IGRA positivity (p = 0.008 and p = 3.9 × 10(-5), respectively). The BCG vaccination was associated with negative IGRA (p = 3 × 10(-4)). Indeterminate IGRA results were associated with age, C-reactive protein, and immunosuppressive treatment (p = 0.005, 0.007, and 0.004, respectively).
  
  
  CONCLUSIONS
  Our data support the combined use of T-SPOT.TB and TST in patients with CIA before biologics introduction. However, despite these good diagnostic values, indeterminate results may complicate the use of IGRA.
authors.affiliation: From the Rheumatology Department and the Immunology Department, CHU Nancy, Nancy; Université de Lorraine, Lorraine, France.
authors.forename: Félicie
authors.initials: F
authors.lastname: Costantino
authors.forename: Marcelo
authors.initials: M
authors.lastname: de Carvalho Bittencourt
authors.forename: Anne-Christine
authors.initials: AC
authors.lastname: Rat
authors.forename: Damien
authors.initials: D
authors.lastname: Loeuille
authors.forename: Hervé
authors.initials: H
authors.lastname: Dintinger
authors.forename: Marie C
authors.initials: MC
authors.lastname: Béné
authors.forename: Gilbert
authors.initials: G
authors.lastname: Faure
authors.forename: Isabelle
authors.initials: I
authors.lastname: Chary-Valckenaere
mesh_terms: D000328:Adult; D018501:Antirheumatic Agents / Q000009:adverse effects / Q000627:therapeutic use; D001172:Arthritis, Rheumatoid / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology; D001500:BCG Vaccine; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D016867:Immunocompromised Host; D007166:Immunosuppressive Agents / Q000009:adverse effects / Q000627:therapeutic use; D059425:Interferon-gamma Release Tests / Q000592:standards* / Q000706:statistics & numerical data; D055985:Latent Tuberculosis / Q000175:diagnosis / Q000453:epidemiology / Q000276:immunology; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012307:Risk Factors; D013167:Spondylitis, Ankylosing / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology; D014374:Tuberculin Test / Q000592:standards* / Q000706:statistics & numerical data
chemical_list: D018501:Antirheumatic Agents; D001500:BCG Vaccine; D007166:Immunosuppressive Agents
keywords: ANKYLOSING SPONDYLITIS; BIOLOGICAL AGENTS; INTERFERON-γ RELEASE TESTS; RHEUMATOID ARTHRITIS; TUBERCULOSIS